Corticosteroid-responsive torticollis as a presenting symptom of multiple sclerosis

Abstract

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system that rarely presents with movement disorder symptoms upon primary manifestation. We report the case of a 45-year-old patient with no history of any medical condition who presented to our clinic with left-sided torticollis. Interestingly, MRI scan of the brain revealed multiple periventricular T2 hyperintense lesions. Analysis of cerebrospinal fluid (CSF) showed that cell numbers and protein concentration were normal, while oligoclonal IgG synthesis was suggestive of chronic intrathecal inflammation. Therefore, clinically isolated syndrome (CIS) was diagnosed as a primary manifestation of relapsing-remitting MS. In the MRI scans, one lesion was found to be localized to the right cerebral peduncle, thus providing a potential link between torticollis and the autoimmune disorder. Furthermore, the symptoms were completely resolved with corticosteroid treatment alone. This is to our knowledge the first description of an MS case in which the sole primary manifestation was torticollis that could be completely resolved with corticosteroid treatment. We therefore suggest performing a cerebral MRI scan with particular focus on demyelinating lesions in patients with focal dystonia, since there is an increasing number of reports describing MS as a potential cause of secondary dystonia. Notably, early corticosteroid therapy might resolve symptoms.